AMR takes over Fire Dept. EMS

[PamelaAnn]

This has been a long-standing legal battle between the county and city over several issues, not about anyone screwing up or any battle between any of us in the field. The overall issue has gone back several years and is now just coming to a head. There are many articles in the archives of the Stockton Record regarding this subject if anyone is interested.

http://www.recordnet.com/

It's basically about who is going to receive the incoming emergency calls first and who governs ALS FD in this county. SFD apparently has a disagreement with the County EMSA and maybe there will be a resolution to this issue, or maybe we will just have to adjust to the new way things are done here for now.

I have seen some speculation on the system here. Our emergency response criteria in this county is as follows:

Code 3 response requires - an ALS ambulance and fire engine (and/or truck depending on the incident)

Code 2 response requires - an ALS ambulance

Our ambulances are generally staffed with one paramedic and one EMT. Most city engines have at least 1 or more paramedic on board and most of the rural departments are still BLS providers. When we arrive on scene with an engine company, we are a team to provide care. Sometimes we arrive first and they assist us and sometimes they arrive first and start care, but ultimately care is turned over to the transporting medic on scene. There are times when having more than one paramedic on scene early in a call is a great asset, particularly in the instance of a multiple shooting, MVA, etc...where a first-in medic has to request additional transport units. It's always been a team effort for us.

I currently work in the southern area of the county, and the FD I respond with is ALS. Our situation is very cohesive and over time relationships are established and we all learn to work with each other. We don't always agree on everything - we are all still human and sometimes have different perspectives on a situation - but ultimately it is the transporting paramedic's responsibility for managing the patient's care and outcome. It is my personal opinion that working with an ALS or BLS provider is not the issue, sometimes a great convenience, but as long as all of us are looking at the patient's best interests all the time there should be no issue from the field side.

With that said - what happens with the higher-ups we have no control over - AHHHH - such is life

Happy Saturday!

Edited September 18, 2010 by PamelaAnn

[Boolancedriver911]

AMR sucks, tries to take over EMS everywhere they go.......they failed in PA....

[speedygodzilla]

Wow this makes no sense. The article didn't mention anything about AMR so I am not convinced they are even involved in this decision. It would make no sense for AMR, county, or whatever to drop ALS from their fire department response. I work in a system much like this one where the fire dept responds on our calls and is ALS and often times gets their before us. There are 10 fire stations (double the amount of ALS ambulances usually) and they receive the 911 call first. So often they get on scene first. For the most part transfer of care from fire to us goes on without any issues. Sure we are human and disagree on things from time to time but it is understood that the transporting paramedic is overall responsible for patient care once on scene, as they are the one writing the patient care report as well as transporting the patient. Usually the fire paramedic does not stay with the patient to the hospital except when the extra hands are needed for a critical patient.

The biggest question I have is WHY? This sounds political. It is to bad, and someone is likely to be injured or die due to the inability of the fire department to intervene with ALS even though they have the training. The calls are rare where the few minutes the fire dept arrives first and ALS interventions will make a true difference but like the article mention CODES etc are great examples of when seconds and minutes can count.

And as for the above comment of AMR sucks I gave a negative reputation due to the negative comment without need or support. We all have our opinions sometimes they arn't appropriate.

[Just Plain Ruff]

AMR sucks, tries to take over EMS everywhere they go.......they failed in PA....

Care to back up that statement or are you just spouting nonsense.

[CBEMT]

It is to bad, and someone is likely to be injured or die due to the inability of the fire department to intervene with ALS even though they have the training.

Too bad the fire department can't back up such a premise with, you know, evidence.

but like the article mention CODES etc are great examples of when seconds and minutes can count.

All it proves is that you don't know what you're talking about. ALS in general cannot be proven to make one iota of difference in cardiac arrest survival, and there is even less evidence for first-response ALS.

Edited September 28, 2010 by CBEMT

[speedygodzilla]

Apparently I was wrong in my thought of ALS increasing CODES survival. After googling it and reading 3 different articles, apparently ALS interventions are not proven to benefit outcome.

However I would like to think they are a standard and someone sue happy could go after the city/county due to the lack of care.

None the less I still believe having ALS first responders (fire dept) is beneficial to our patients and community. Don't have anything to back it up other than personal experience.

[CBEMT]

However I would like to think they are a standard and someone sue happy could go after the city/county due to the lack of care.

How can the municipality be sued for not providing a service delivery model that has no basis in science? Hell, if they wanted to they could contract for a BLS-only transport service and probably be in no more jeapordy than they are by cutting out FD-based ALS. Since most municipalities are under no statutory obligation to provide EMS in the first place, anything they do is, legally, just a bonus service anyway.

None the less I still believe having ALS first responders (fire dept) is beneficial to our patients and community. Don't have anything to back it up other than personal experience.

As such, you are simply part of the problem, hindering the growth and development of EMS as a profession. Medical care is not about your feelings or "personal experience." Any moron can tell stories to justify their personal, biased opinion of how things should be. Medicine is about what works; what is beneficial to patient care, versus what doesn't work, is inefficient, and what does not improve patient outcomes. Guess which side you and the SFD are on?

Edited September 28, 2010 by CBEMT

[speedygodzilla]

How can the municipality be sued for not providing a service delivery model that has no basis in science? Hell, if they wanted to they could contract for a BLS-only transport service and probably be in no more jeapordy than they are by cutting out FD-based ALS. Since most municipalities are under no statutory obligation to provide EMS in the first place, anything they do is, legally, just a bonus service anyway.

As such, you are simply part of the problem, hindering the growth and development of EMS as a profession. Medical care is not about your feelings or "personal experience." Any moron can tell stories to justify their personal, biased opinion of how things should be. Medicine is about what works; what is beneficial to patient care, versus what doesn't work, is inefficient, and what does not improve patient outcomes. Guess which side you and the SFD are on?

The whole sue thing is hypothetical and even more so very unlikely to go anywhere. It is sad to think that even though someone has the training to improve a patient's outcome they are unable to due to politics.

I am part of the problem? HA HA! I can tell you that having ALS first responders does work, and is beneficial to patient care. Where I work we work great together and I consider them (ALS Fire) an important part of the team. I don't have to guess what side I am on, I know, it's the patient's side.

It is hindering in the growth of EMS profession to go from ALS to BLS. I am not saying BLS is not important, heck it is the backbone. How am I hindering the growth of EMS with the thought of ALS first responders being beneficial? I really hope this is not another bickering match abouts fire's role EMS. In order to be seen as a true profession we need to start being professional!

[CBEMT]

In order to be seen as a true profession we need to start being professional!

In order to grow and advance the profession, we need to enact best practices based on medical science- not continue response models on what best secures firefighter's jobs.

[speedygodzilla]

In order to grow and advance the profession, we need to enact best practices based on medical science- not continue response models on what best secures firefighter's jobs.

It is not about securing firefighter's role/job but taking care of our patients and offering them the best care possible.